PAEA Internal Medicine EOR
Questions and Answers Scored A
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
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
, 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
Questions and Answers Scored A
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
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
, 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
