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PAEA Internal Medicine EOR Accurate answers
for exam success.
Bell's Palsy - Answer causes cranial nerve 7 dysfunction
S/S of Bell's Palsy - Answer Has forehead involvement (whereas a stroke does not affect
forehead movement), facial weakness, inability to keep one eye closed
Treatment for Bell's palsy - Answer Prednisone 60mg x 5 days, Valcyclovir 1000mg TID
x 7 days, artificial tears, lacri lube at night
When can I use tPA? - Answer ischemic stroke presenting within <3 hrs and CT head
negative
How do you treat high BP with stroke? - Answer Nitroprusside (short half life, easy to
titrate) or IV labetalol
What do you use for anticoagulation/antiplatelet therapy in stroke? - Answer ASA (not in
hemorrhagic), heparin for thrombosis
What do you do differently to treat hemorrhagic stroke? - Answer Give prophylactic
anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy
contraindicated
Types of Hemorrhagic Stroke - Answer 1. Intracerebral (10%): results from rupture of
small arterioles
2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into subarachnoid space)
Causes of Intracerebral hemorrhagic stroke are what? - Answer HTN, amyloidosis,
iatrogenic anticoagulation, vascular malformations, cocaine use
Causes of Subarachnoid hemorrhagic stroke are what? - Answer berry aneurysm rupture,
vascular malformation rupture
Signs and symptoms of Intracerebral hemorrhagic stroke are what? - Answer ICP rises,
vasoconstriction-sweating
Signs and symptoms of Subarachnoid hemorrhagic stroke are what? - Answer may be
preceded by warning headache, neck/back pain, "worst headache of my life," thunderclap, may
have loss of consciousness
Treatment of Subarachnoid hemorrhage - Answer surgery, control hypertension,
analgesics
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What is Complex regional pain syndrome (CRPS) - Answer Chronic arm or leg pain
developing after injury, surgery, stroke, or heart attack.
Signs and symptoms of complex regional pain syndrome are what? - Answer Pain out of
proportion to injury. ANS sx: swelling, extremity color changes, increased nail and hair growth.
Treatment for complex regional pain syndrome - Answer Amitriptyline, nortriptyline,
gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive therapy;
Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation
Vit C prophylaxis after fx
Imaging modality used to diagnose Subarachnoid Hemorrhage? - Answer CT without
contrast. If CT negative but still suspect SAH, do LP to look for RBC or xanthochromia (will not
develop until 12hrs after onset)
Delirium - Answer transient disorder characterized by impaired attention, perception,
memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced alertness,
activity levels change rapidly.
Treatment of Delirium - Answer treat underlying cause, Haloperidol 5-10mg for agitation,
Lorazepam 0.5-2 mg
Dementia - Answer Loss of mental capacity. Psychosocial level and cognitive abilities
deteriorate and behavioral problems develop. Largest categories are Alzheimer dz and vascular
dementia. Hallucinations, delusion, depression, repetitive behavior are common.
Treatment of Dementia - Answer Antipsychotics to manage psychosis
Essential tremor does not occur at rest, occurs bilaterally, and has no indication of other neuro
signs. How do you treat essential tremor? - Answer Propranolol, Primidone (can combine
these 2 if needed)
Guillian Barre Syndrome - Answer Idiopathic polyneuropathy often following minor
infections, immunizations or surgical procedures. Most times no cause is identified.
How long does Guillian Barre Syndrome last? - Answer worst at 2-4 weeks after onset,
plateaus next 2-4 weeks, remits weeks-moats
Signs and symptoms of Guillian Barre Syndrome - Answer ascending symmetric
weakness and loss of DTR's, proximal muscles affected more than distal. Sensory abnormalities,
pain, tachycardia, sweating, impaired pulmonary function, paralytic ileus
How do you diagnose Guillian Barre? - Answer no fever at onset, CSF protein >45 and
low WBC, MRI shows selective enhancement of anterior spinal nerve roots
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Treatment of Guillian Barre Syndrome - Answer IVIG or plasmapheresis, may need
intubation. Hospitalized pt with close monitoring. Recovery is slow but approximately 60%
make full recovery within 1 year.
What disease is a systemic inflammatory condition of medium and large vessels affecting people
over 50 years old, coexists with polymyalgia rheumatica and can cause blindness if not treated
appropriately? - Answer Giant cell arteritis
Signs and symptoms of Giant Cell Arteritis - Answer headache, scalp tenderness, jaw
claudication, throat pain, diplopia
Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis
Giant Cell Arteritis Treatment - Answer Steroids immediately, do not wait for biopsy
results. Give low dose aspirin too.
Describe a Migraine Headache? - Answer unilateral location, pulsatile quality, moderate
to severe intensity, aggravated by movement, nausea, vomiting, photophobia, phonophobia
lasting 4-72 hours
Migraine treatment - Answer NSAIDs, Triptans, antiemetics
What is a Cluster Headache? - Answer severe, unilateral headache localized to
periorbital/temporal area accompanied by lacrimation, rhinorrhea, ptosis, myosis, nasal
congestion, eyelid edema
-Occurs in clusters meaning 1-8 daily attacks lasting 15-90 minutes for 4-6 weeks... followed by
pain free interval 3-6 months
Cluster headache treatment - Answer Oxygen, Sumatriptan 6mg SQ, start preventive
therapy as soon as headache onset to suppress attacks over expected duration of cluster period
Preventive therapies for cluster headache lasting more than 2 months - Answer Verapamil
240-960mg given in 3 daily doses
What is a Tension Headache? - Answer mild to moderate intensity, located bilateral-
frontal areas, dull band like pain, lasting for hours, associated with stress. No nausea, vomiting,
neuro deficits.
Tension HA treatment - Answer NSAIDs or ASA combined with caffeine. APAP less
effective but preferred in pregnancy. 2nd line therapies are antidepressants (amitriptyline)
Huntington Disease - Answer inherited disorder, develops after 30 years old, progressive
chorea and dementia, usually fatal within 15-20 years
Signs and symptoms of Huntington Disease - Answer mental changes, restless, dystonic
posturing, severe choreiform movements
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Empiric treatment for bacterial meningitis - Answer Ceftriaxone 2g IV and Vancomycin
=/- Acyclovifr, Dexamethasone 10 mg IV; spupportive care
Bacterial meningitis opening pressure of LP - Answer >300mm
Viral meningitis opening pressure of LP - Answer <300mm
Bacterial and Viral meningitis WBC in CSF from lumbar puncture - Answer Bacterial:
>1000
Viral: <1000
Bacterial and Viral meningitis glucose in CSF from lumbar puncture - Answer Bacterial:
<40
Viral: >40
Bacterial and Viral meningitis protein in CSF from lumbar puncture - Answer Bacterial:
>200
Viral: <200
What is Myasthenia gravis? - Answer involves muscle weakness and fatigue improves
with rest. Common in young women and old men.
Signs and symptoms of Myasthenia gravis? - Answer ptosis, diplopia, difficulty chewing,
limb weakness, respiratory difficulties
Parkinson's Disease - Answer nerve cell damage in brain causes dopamine levels to drop
leading to sings and symptoms
Essential features of Parkinson's Disease - Answer resting tremor, bradykinesia, rigidity,
postural instability
Treatment for Parkinson's Disease - Answer Mainstay of tx are Levodopa and Carbidopa
(when using together can reduce Levodopa to reduce AE)
Convulsive (grand-mal or tonic-clonic) seizures - Answer associated with postictal
obtundation and confusion lasting minutes to hours. Tonic-clonic muscle contractions of all
extremities, LOC, incontinence, flaccid/unconscious after attack
Non-Convulsive (absence) seizures - Answer Associated wtih only minor motor activity
such as blinking or facial twitching. Begin in childhood typically subsiding before adulthood.
Signs and symptoms of non-convulsive (absence) seizures - Answer brief, often
unnoticeable, episodes of impaired consciousness lasting seconds occurring up to 100 times per
day. Present as staring spells.
