PAEA Internal Medicine EOR [2026/2027] |
UPDATED ACTUAL Exam Question and Answer
| Simplified Study Guide
• what cranial nerve is affected in Bell's Palsy? -✓✓ cranial nerve 7 (facial)
• what differentiates Bell's Palsy from stroke -✓✓ Bell's Palsy HAS forehead
involvement
• s/sx of Bell's palsy -✓✓ facial weakness, facial paralysis, or twitching, inability to keep
one eye closed or excessive tears, drooping corner of mouth, dry mouth, and impaired
taste
• Treatment for Bell's palsy -✓✓ -*Prednisone* 60mg for 5 days
-*Valcyclovir* 1000mg for 7 days
-artificial tears
-lacri lube at night
• Define stroke -✓✓ any disease process that interrupts blood flow to the brain. can be
ischemic or hemorrhagic
• gold standard diagnostic test for stroke -✓✓ CT angiogram
• S/sx of a stroke -✓✓ -sudden numbness/weakness,
-sudden confusion/aphasia,
-memory deficit,
-visual deficit,
-dizzy,
-sudden HA with no cause
• tPA MOA -✓✓ enzyme that binds to fibrin in a newly formed clot and directly converts
plasminogen to plasmin
• When can I use tPA? -✓✓ ischemic stroke presenting within <3 hrs and CT head
negative
• Dosing of tPA -✓✓ -*0.9 mg/kg IV*,
-max dose of *90 mg*.
-10% administered as bolus with rest infused over next 60 minutes
• 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
• Ischemic stroke is the most common type (87%) and has what signs and symptoms? -
✓✓ No headache, not visible on CT without contrast until 6 hours post stroke
• What are the types of Ischemic Stroke? -✓✓ 1. Thrombotic: narrowing of damaged
vascular lumen by an in situ process, usually clot.
2. Embolic (20%): obstruction of normal vascular lumen by intravascular material from
remote source
• 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 the name for the disease that beings following an operation, a fracture, or
vascular event such as stroke or heart attack? -✓✓ Complex regional pain syndrome
(CRPS)
• Signs and symptoms of complex regional pain syndrome are what? -✓✓ regional pain
in affected limb, restricted mobility, edema, color changes of skin, spotty bone thinning.
Hallmark is severe burning or throbbing pain with associated allodynia in affected
extremity.
,• 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
• _____ accounts for 75% of nontraumatic cases of subarachnoid hemorrhage. -✓✓
berry aneurysm
• 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
• GCS -✓✓
• 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 -✓✓ 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 do you use in conjunction with abortive therapies for migraine to reduce risk of
early headache recurrence? -✓✓ dexamethasone 10-25 mg IV/IM
• 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
• Preventive therapies for cluster headache lasting less than 2 months -✓✓ Prednisone
60-100mg daily x5 days, taper with 10mg
UPDATED ACTUAL Exam Question and Answer
| Simplified Study Guide
• what cranial nerve is affected in Bell's Palsy? -✓✓ cranial nerve 7 (facial)
• what differentiates Bell's Palsy from stroke -✓✓ Bell's Palsy HAS forehead
involvement
• s/sx of Bell's palsy -✓✓ facial weakness, facial paralysis, or twitching, inability to keep
one eye closed or excessive tears, drooping corner of mouth, dry mouth, and impaired
taste
• Treatment for Bell's palsy -✓✓ -*Prednisone* 60mg for 5 days
-*Valcyclovir* 1000mg for 7 days
-artificial tears
-lacri lube at night
• Define stroke -✓✓ any disease process that interrupts blood flow to the brain. can be
ischemic or hemorrhagic
• gold standard diagnostic test for stroke -✓✓ CT angiogram
• S/sx of a stroke -✓✓ -sudden numbness/weakness,
-sudden confusion/aphasia,
-memory deficit,
-visual deficit,
-dizzy,
-sudden HA with no cause
• tPA MOA -✓✓ enzyme that binds to fibrin in a newly formed clot and directly converts
plasminogen to plasmin
• When can I use tPA? -✓✓ ischemic stroke presenting within <3 hrs and CT head
negative
• Dosing of tPA -✓✓ -*0.9 mg/kg IV*,
-max dose of *90 mg*.
-10% administered as bolus with rest infused over next 60 minutes
• 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
• Ischemic stroke is the most common type (87%) and has what signs and symptoms? -
✓✓ No headache, not visible on CT without contrast until 6 hours post stroke
• What are the types of Ischemic Stroke? -✓✓ 1. Thrombotic: narrowing of damaged
vascular lumen by an in situ process, usually clot.
2. Embolic (20%): obstruction of normal vascular lumen by intravascular material from
remote source
• 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 the name for the disease that beings following an operation, a fracture, or
vascular event such as stroke or heart attack? -✓✓ Complex regional pain syndrome
(CRPS)
• Signs and symptoms of complex regional pain syndrome are what? -✓✓ regional pain
in affected limb, restricted mobility, edema, color changes of skin, spotty bone thinning.
Hallmark is severe burning or throbbing pain with associated allodynia in affected
extremity.
,• 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
• _____ accounts for 75% of nontraumatic cases of subarachnoid hemorrhage. -✓✓
berry aneurysm
• 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
• GCS -✓✓
• 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 -✓✓ 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 do you use in conjunction with abortive therapies for migraine to reduce risk of
early headache recurrence? -✓✓ dexamethasone 10-25 mg IV/IM
• 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
• Preventive therapies for cluster headache lasting less than 2 months -✓✓ Prednisone
60-100mg daily x5 days, taper with 10mg
