PAEA Internal Medicine EOR question
with answers
Bell's Palsy - -causes cranial nerve 7 dysfunction
-S/S of Bell's Palsy - -Has forehead involvement (whereas a stroke does not affect
forehead movement), facial weakness, inability to keep one eye closed
-Treatment for Bell's palsy - -Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x
7 days, artificial tears, lacri lube at night
-When can I use tPA? - -ischemic stroke presenting within <3 hrs and CT head
negative
-How do you treat high BP with stroke? - -Nitroprusside (short half life, easy to
titrate) or IV labetalol
-What do you use for anticoagulation/antiplatelet therapy in stroke? - -ASA (not in
hemorrhagic), heparin for thrombosis
-What do you do differently to treat hemorrhagic stroke? - -Give prophylactic
anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy
contraindicated
-Types of Hemorrhagic Stroke - -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? - -HTN, amyloidosis,
iatrogenic anticoagulation, vascular malformations, cocaine use
-Causes of Subarachnoid hemorrhagic stroke are what? - -berry aneurysm rupture,
vascular malformation rupture
-Signs and symptoms of Intracerebral hemorrhagic stroke are what? - -ICP rises,
vasoconstriction-sweating
-Signs and symptoms of Subarachnoid hemorrhagic stroke are what? - -may be
preceded by warning headache, neck/back pain, "worst headache of my life,"
thunderclap, may have loss of consciousness
-Treatment of Subarachnoid hemorrhage - -surgery, control hypertension,
analgesics
-What is Complex regional pain syndrome (CRPS) - -Chronic arm or leg pain
developing after injury, surgery, stroke, or heart attack.
,-Signs and symptoms of complex regional pain syndrome are what? - -Pain out of
proportion to injury. ANS sx: swelling, extremity color changes, increased nail and
hair growth.
-Treatment for complex regional pain syndrome - -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? - -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 - -transient disorder characterized by impaired attention, perception,
memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced
alertness, activity levels change rapidly.
-Treatment of Delirium - -treat underlying cause, Haloperidol 5-10mg for agitation,
Lorazepam 0.5-2 mg
-Dementia - -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 - -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? - -Propranolol, Primidone (can
combine these 2 if needed)
-Guillian Barre Syndrome - -Idiopathic polyneuropathy often following minor
infections, immunizations or surgical procedures. Most times no cause is identified.
-How long does Guillian Barre Syndrome last? - -worst at 2-4 weeks after onset,
plateaus next 2-4 weeks, remits weeks-moats
-Signs and symptoms of Guillian Barre Syndrome - -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? - -no fever at onset, CSF protein >45 and low
WBC, MRI shows selective enhancement of anterior spinal nerve roots
-Treatment of Guillian Barre Syndrome - -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? - -Giant cell arteritis
-Signs and symptoms of Giant Cell Arteritis - -headache, scalp tenderness, jaw
claudication, throat pain, diplopia
Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis
-Giant Cell Arteritis Treatment - -Steroids immediately, do not wait for biopsy
results. Give low dose aspirin too.
-Describe a Migraine Headache? - -unilateral location, pulsatile quality, moderate to
severe intensity, aggravated by movement, nausea, vomiting, photophobia,
phonophobia
lasting 4-72 hours
-Migraine treatment - -NSAIDs, Triptans, antiemetics
-What is a Cluster Headache? - -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 - -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 - -Verapamil
240-960mg given in 3 daily doses
-What is a Tension Headache? - -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 - -NSAIDs or ASA combined with caffeine. APAP less effective
but preferred in pregnancy. 2nd line therapies are antidepressants (amitriptyline)
-Huntington Disease - -inherited disorder, develops after 30 years old, progressive
chorea and dementia, usually fatal within 15-20 years
-Signs and symptoms of Huntington Disease - -mental changes, restless, dystonic
posturing, severe choreiform movements
-Empiric treatment for bacterial meningitis - -Ceftriaxone 2g IV and Vancomycin =/-
Acyclovifr, Dexamethasone 10 mg IV; spupportive care
-Bacterial meningitis opening pressure of LP - ->300mm
-Viral meningitis opening pressure of LP - -<300mm
, -Bacterial and Viral meningitis WBC in CSF from lumbar puncture - -Bacterial:
>1000
Viral: <1000
-Bacterial and Viral meningitis glucose in CSF from lumbar puncture - -Bacterial:
<40
Viral: >40
-Bacterial and Viral meningitis protein in CSF from lumbar puncture - -Bacterial:
>200
Viral: <200
-What is Myasthenia gravis? - -involves muscle weakness and fatigue improves with
rest. Common in young women and old men.
-Signs and symptoms of Myasthenia gravis? - -ptosis, diplopia, difficulty chewing,
limb weakness, respiratory difficulties
-Parkinson's Disease - -nerve cell damage in brain causes dopamine levels to drop
leading to sings and symptoms
-Essential features of Parkinson's Disease - -resting tremor, bradykinesia, rigidity,
postural instability
-Treatment for Parkinson's Disease - -Mainstay of tx are Levodopa and Carbidopa
(when using together can reduce Levodopa to reduce AE)
-Convulsive (grand-mal or tonic-clonic) seizures - -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 - -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 - -brief, often
unnoticeable, episodes of impaired consciousness lasting seconds occurring up to
100 times per day. Present as staring spells.
-Focal (partial) seizures are Complex and Simple. Whats the difference between the
two? - -Complex: characterize by aura, followed by impaired consciousness lasting
seconds to minutes. N/V, focal impairments may occur.
Simple: consciousness maintained. May be tonic-clonic activity.
-Todd's paralysis - -Postictal weakness or paralysis that is often unilateral and
resolves over 24 hours
-Treatment of generalized convulsive, simple partial and complex partial seizures is
what? - -Carbamazepine, Phenytoin, Valproic Acid
with answers
Bell's Palsy - -causes cranial nerve 7 dysfunction
-S/S of Bell's Palsy - -Has forehead involvement (whereas a stroke does not affect
forehead movement), facial weakness, inability to keep one eye closed
-Treatment for Bell's palsy - -Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x
7 days, artificial tears, lacri lube at night
-When can I use tPA? - -ischemic stroke presenting within <3 hrs and CT head
negative
-How do you treat high BP with stroke? - -Nitroprusside (short half life, easy to
titrate) or IV labetalol
-What do you use for anticoagulation/antiplatelet therapy in stroke? - -ASA (not in
hemorrhagic), heparin for thrombosis
-What do you do differently to treat hemorrhagic stroke? - -Give prophylactic
anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy
contraindicated
-Types of Hemorrhagic Stroke - -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? - -HTN, amyloidosis,
iatrogenic anticoagulation, vascular malformations, cocaine use
-Causes of Subarachnoid hemorrhagic stroke are what? - -berry aneurysm rupture,
vascular malformation rupture
-Signs and symptoms of Intracerebral hemorrhagic stroke are what? - -ICP rises,
vasoconstriction-sweating
-Signs and symptoms of Subarachnoid hemorrhagic stroke are what? - -may be
preceded by warning headache, neck/back pain, "worst headache of my life,"
thunderclap, may have loss of consciousness
-Treatment of Subarachnoid hemorrhage - -surgery, control hypertension,
analgesics
-What is Complex regional pain syndrome (CRPS) - -Chronic arm or leg pain
developing after injury, surgery, stroke, or heart attack.
,-Signs and symptoms of complex regional pain syndrome are what? - -Pain out of
proportion to injury. ANS sx: swelling, extremity color changes, increased nail and
hair growth.
-Treatment for complex regional pain syndrome - -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? - -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 - -transient disorder characterized by impaired attention, perception,
memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced
alertness, activity levels change rapidly.
-Treatment of Delirium - -treat underlying cause, Haloperidol 5-10mg for agitation,
Lorazepam 0.5-2 mg
-Dementia - -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 - -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? - -Propranolol, Primidone (can
combine these 2 if needed)
-Guillian Barre Syndrome - -Idiopathic polyneuropathy often following minor
infections, immunizations or surgical procedures. Most times no cause is identified.
-How long does Guillian Barre Syndrome last? - -worst at 2-4 weeks after onset,
plateaus next 2-4 weeks, remits weeks-moats
-Signs and symptoms of Guillian Barre Syndrome - -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? - -no fever at onset, CSF protein >45 and low
WBC, MRI shows selective enhancement of anterior spinal nerve roots
-Treatment of Guillian Barre Syndrome - -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? - -Giant cell arteritis
-Signs and symptoms of Giant Cell Arteritis - -headache, scalp tenderness, jaw
claudication, throat pain, diplopia
Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis
-Giant Cell Arteritis Treatment - -Steroids immediately, do not wait for biopsy
results. Give low dose aspirin too.
-Describe a Migraine Headache? - -unilateral location, pulsatile quality, moderate to
severe intensity, aggravated by movement, nausea, vomiting, photophobia,
phonophobia
lasting 4-72 hours
-Migraine treatment - -NSAIDs, Triptans, antiemetics
-What is a Cluster Headache? - -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 - -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 - -Verapamil
240-960mg given in 3 daily doses
-What is a Tension Headache? - -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 - -NSAIDs or ASA combined with caffeine. APAP less effective
but preferred in pregnancy. 2nd line therapies are antidepressants (amitriptyline)
-Huntington Disease - -inherited disorder, develops after 30 years old, progressive
chorea and dementia, usually fatal within 15-20 years
-Signs and symptoms of Huntington Disease - -mental changes, restless, dystonic
posturing, severe choreiform movements
-Empiric treatment for bacterial meningitis - -Ceftriaxone 2g IV and Vancomycin =/-
Acyclovifr, Dexamethasone 10 mg IV; spupportive care
-Bacterial meningitis opening pressure of LP - ->300mm
-Viral meningitis opening pressure of LP - -<300mm
, -Bacterial and Viral meningitis WBC in CSF from lumbar puncture - -Bacterial:
>1000
Viral: <1000
-Bacterial and Viral meningitis glucose in CSF from lumbar puncture - -Bacterial:
<40
Viral: >40
-Bacterial and Viral meningitis protein in CSF from lumbar puncture - -Bacterial:
>200
Viral: <200
-What is Myasthenia gravis? - -involves muscle weakness and fatigue improves with
rest. Common in young women and old men.
-Signs and symptoms of Myasthenia gravis? - -ptosis, diplopia, difficulty chewing,
limb weakness, respiratory difficulties
-Parkinson's Disease - -nerve cell damage in brain causes dopamine levels to drop
leading to sings and symptoms
-Essential features of Parkinson's Disease - -resting tremor, bradykinesia, rigidity,
postural instability
-Treatment for Parkinson's Disease - -Mainstay of tx are Levodopa and Carbidopa
(when using together can reduce Levodopa to reduce AE)
-Convulsive (grand-mal or tonic-clonic) seizures - -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 - -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 - -brief, often
unnoticeable, episodes of impaired consciousness lasting seconds occurring up to
100 times per day. Present as staring spells.
-Focal (partial) seizures are Complex and Simple. Whats the difference between the
two? - -Complex: characterize by aura, followed by impaired consciousness lasting
seconds to minutes. N/V, focal impairments may occur.
Simple: consciousness maintained. May be tonic-clonic activity.
-Todd's paralysis - -Postictal weakness or paralysis that is often unilateral and
resolves over 24 hours
-Treatment of generalized convulsive, simple partial and complex partial seizures is
what? - -Carbamazepine, Phenytoin, Valproic Acid
