PAEA Internal Medicine EOR Exam questions with complete solution

PAEA Internal Medicine EOR Exam questions with complete solution Bell's Palsy ANS-causes cranial nerve 7 dysfunction S/S of Bell's Palsy ANS-Has forehead involvement (whereas a stroke does not affect forehead movement), facial weakness, inability to keep one eye closed Treatment for Bell's palsy ANS-Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x 7 days, artificial tears, lacri lube at night When can I use tPA? ANS-ischemic stroke presenting within 3 hrs and CT head negative How do you treat high BP with stroke? ANS-Nitroprusside (short half life, easy to titrate) or IV labetalol What do you use for anticoagulation/antiplatelet therapy in stroke? ANS-ASA (not in hemorrhagic), heparin for thrombosis What do you do differently to treat hemorrhagic stroke? ANS-Give prophylactic anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy contraindicated Types of Hemorrhagic Stroke ANS-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? ANS-HTN, amyloidosis, iatrogenic anticoagulation, vascular malformations, cocaine use Causes of Subarachnoid hemorrhagic stroke are what? ANS-berry aneurysm rupture, vascular malformation rupture Signs and symptoms of Intracerebral hemorrhagic stroke are what? ANS-ICP rises, vasoconstriction-sweating Signs and symptoms of Subarachnoid hemorrhagic stroke are what? ANS-may be preceded by warning headache, neck/back pain, "worst headache of my life," thunderclap, may have loss of consciousness Treatment of Subarachnoid hemorrhage ANS-surgery, control hypertension, analgesics What is Complex regional pain syndrome (CRPS) ANS-Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack. Signs and symptoms of complex regional pain syndrome are what? ANS-Pain out of proportion to injury. ANS sx: swelling, extremity color changes, increased nail and hair growth. Treatment for complex regional pain syndrome ANS-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? ANS-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 ANS-transient disorder characterized by impaired attention, perception, memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced alertness, activity levels change rapidly. Treatment of Delirium ANS-treat underlying cause, Haloperidol 5-10mg for agitation, Lorazepam 0.5-2 mg Dem