PAEA Internal Medicine EOR [2026/2027] |
UPDATED ACTUAL Exam Question and
Answer | Final Review Guide
• 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 (clips vs coils), 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 -✓✓ progressive dementia, involuntary
writhing of muscle groups, 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
UPDATED ACTUAL Exam Question and
Answer | Final Review Guide
• 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 (clips vs coils), 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 -✓✓ progressive dementia, involuntary
writhing of muscle groups, 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
