Internal Medicine EOR Neurology Exam(Smarty PANCE)
What is Bell palsy? Acute idiopathic unilateral facial nerve (CN VII) paralysis - most common cause
of facial paralysis
What are the clinical features of Bell palsy? Sudden unilateral facial weakness, inability to close eye, loss of forehead
wrinkles, droop of mouth, loss of nasolabial fold
How is Bell palsy differentiated from stroke? Bell palsy: affects forehead (cannot wrinkle forehead); Stroke: forehead spared
(can wrinkle forehead) due to bilateral innervation
What is the treatment for Bell palsy? Prednisone 60-80mg daily x 7-10 days (within 72 hours of onset), eye protection
(artificial tears, eye patch at night)
What is the role of antivirals in Bell palsy? Valacyclovir may be added to corticosteroids for severe cases, though evidence
is mixed - not used alone
What is the prognosis of Bell palsy? 70-80% complete recovery within 3 months, earlier treatment improves outcomes
What complication should be prevented in Bell palsy? Corneal abrasion/ulceration due to inability to close eye - requires lubrication and
protective measures
What is a cerebral aneurysm? Abnormal focal dilation of cerebral artery wall, typically at bifurcations in Circle of
Willis - risk of rupture causing SAH
What are the risk factors for cerebral aneurysm? Hypertension, smoking, family history, polycystic kidney disease, Ehlers-Danlos
syndrome, coarctation of aorta
What is the classic presentation of ruptured cerebral Sudden "thunderclap" headache (worst headache of life), nuchal rigidity,
aneurysm? photophobia, loss of consciousness
What is the initial diagnostic test for suspected SAH? Non-contrast head CT - shows blood in subarachnoid space in 95% if done
within 24 hours
What test is performed if CT is negative but SAH Lumbar puncture - look for xanthochromia (yellow CSF from RBC breakdown)
suspected? and elevated RBC count
What imaging confirms aneurysm location? CT angiography or catheter angiography - used for surgical/endovascular
planning
What is the definitive treatment for cerebral aneurysm? Surgical clipping or endovascular coiling to prevent rebleeding - prevent
vasospasm with nimodipine
What is a cerebrovascular accident (stroke)? Acute neurologic deficit from interruption of blood supply to brain - ischemic
(87%) or hemorrhagic (13%)
What are the symptoms of stroke? Use mnemonic FAST Face drooping, Arm weakness, Speech difficulty, Time to call 911
, Internal Medicine EOR Neurology Exam(Smarty PANCE)
What is the time window for tPA in acute ischemic Within 4.5 hours of symptom onset (3 hours preferred) - after excluding
stroke? hemorrhage on CT
What are contraindications to tPA? Recent surgery/trauma, active bleeding, prior ICH, BP >185/110, INR >1.7,
platelets <100,000
What imaging is essential before tPA administration? Non-contrast head CT to exclude hemorrhagic stroke - CT angiography to
identify large vessel occlusion
What are the major stroke territories and symptoms? MCA: contralateral weakness/sensory loss, aphasia; ACA: leg > arm weakness;
PCA: visual field defects
What secondary prevention is given after ischemic Antiplatelet therapy (aspirin or clopidogrel), statin, blood pressure control, treat
stroke? atrial fibrillation
What distinguishes cluster headaches from other Severe unilateral periorbital pain with ipsilateral autonomic features - attacks
headaches? occur in clusters
What are the autonomic features of cluster headaches? Lacrimation, conjunctival injection, rhinorrhea, nasal congestion, ptosis, miosis -
all ipsilateral to pain
What is the typical pattern of cluster headache attacks? Multiple attacks (1-8 per day) lasting 15-180 minutes, often nocturnal, occur in
clusters for weeks-months
What is the acute treatment for cluster headache? 100% oxygen 12-15 L/min via non-rebreather mask x 15 minutes, sumatriptan
injection (6mg SC)
What is the preventive treatment for cluster headaches? Verapamil (first-line), lithium, topiramate - started during cluster period
What defines coma? State of unconsciousness with no response to verbal or painful stimuli - eyes
remain closed
What is the Glasgow Coma Scale and its components? 15-point scale: Eye opening (4), Verbal response (5), Motor response (6) - score
≤8 indicates severe brain injury
What is the initial management of coma? Use mnemonic Dextrose (check glucose), Oxygen, Naloxone (if opioid suspected), Thiamine
DONT (before glucose in alcoholics)
What imaging is essential in evaluating coma? Non-contrast head CT to rule out hemorrhage, mass lesion, herniation
What are common reversible causes of coma? Hypoglycemia, drug overdose, hepatic encephalopathy, uremia, infection, seizure
(postictal state)
What is Complex Regional Pain Syndrome (CRPS)? Chronic neuropathic pain syndrome with autonomic and inflammatory features
disproportionate to inciting event
What is Bell palsy? Acute idiopathic unilateral facial nerve (CN VII) paralysis - most common cause
of facial paralysis
What are the clinical features of Bell palsy? Sudden unilateral facial weakness, inability to close eye, loss of forehead
wrinkles, droop of mouth, loss of nasolabial fold
How is Bell palsy differentiated from stroke? Bell palsy: affects forehead (cannot wrinkle forehead); Stroke: forehead spared
(can wrinkle forehead) due to bilateral innervation
What is the treatment for Bell palsy? Prednisone 60-80mg daily x 7-10 days (within 72 hours of onset), eye protection
(artificial tears, eye patch at night)
What is the role of antivirals in Bell palsy? Valacyclovir may be added to corticosteroids for severe cases, though evidence
is mixed - not used alone
What is the prognosis of Bell palsy? 70-80% complete recovery within 3 months, earlier treatment improves outcomes
What complication should be prevented in Bell palsy? Corneal abrasion/ulceration due to inability to close eye - requires lubrication and
protective measures
What is a cerebral aneurysm? Abnormal focal dilation of cerebral artery wall, typically at bifurcations in Circle of
Willis - risk of rupture causing SAH
What are the risk factors for cerebral aneurysm? Hypertension, smoking, family history, polycystic kidney disease, Ehlers-Danlos
syndrome, coarctation of aorta
What is the classic presentation of ruptured cerebral Sudden "thunderclap" headache (worst headache of life), nuchal rigidity,
aneurysm? photophobia, loss of consciousness
What is the initial diagnostic test for suspected SAH? Non-contrast head CT - shows blood in subarachnoid space in 95% if done
within 24 hours
What test is performed if CT is negative but SAH Lumbar puncture - look for xanthochromia (yellow CSF from RBC breakdown)
suspected? and elevated RBC count
What imaging confirms aneurysm location? CT angiography or catheter angiography - used for surgical/endovascular
planning
What is the definitive treatment for cerebral aneurysm? Surgical clipping or endovascular coiling to prevent rebleeding - prevent
vasospasm with nimodipine
What is a cerebrovascular accident (stroke)? Acute neurologic deficit from interruption of blood supply to brain - ischemic
(87%) or hemorrhagic (13%)
What are the symptoms of stroke? Use mnemonic FAST Face drooping, Arm weakness, Speech difficulty, Time to call 911
, Internal Medicine EOR Neurology Exam(Smarty PANCE)
What is the time window for tPA in acute ischemic Within 4.5 hours of symptom onset (3 hours preferred) - after excluding
stroke? hemorrhage on CT
What are contraindications to tPA? Recent surgery/trauma, active bleeding, prior ICH, BP >185/110, INR >1.7,
platelets <100,000
What imaging is essential before tPA administration? Non-contrast head CT to exclude hemorrhagic stroke - CT angiography to
identify large vessel occlusion
What are the major stroke territories and symptoms? MCA: contralateral weakness/sensory loss, aphasia; ACA: leg > arm weakness;
PCA: visual field defects
What secondary prevention is given after ischemic Antiplatelet therapy (aspirin or clopidogrel), statin, blood pressure control, treat
stroke? atrial fibrillation
What distinguishes cluster headaches from other Severe unilateral periorbital pain with ipsilateral autonomic features - attacks
headaches? occur in clusters
What are the autonomic features of cluster headaches? Lacrimation, conjunctival injection, rhinorrhea, nasal congestion, ptosis, miosis -
all ipsilateral to pain
What is the typical pattern of cluster headache attacks? Multiple attacks (1-8 per day) lasting 15-180 minutes, often nocturnal, occur in
clusters for weeks-months
What is the acute treatment for cluster headache? 100% oxygen 12-15 L/min via non-rebreather mask x 15 minutes, sumatriptan
injection (6mg SC)
What is the preventive treatment for cluster headaches? Verapamil (first-line), lithium, topiramate - started during cluster period
What defines coma? State of unconsciousness with no response to verbal or painful stimuli - eyes
remain closed
What is the Glasgow Coma Scale and its components? 15-point scale: Eye opening (4), Verbal response (5), Motor response (6) - score
≤8 indicates severe brain injury
What is the initial management of coma? Use mnemonic Dextrose (check glucose), Oxygen, Naloxone (if opioid suspected), Thiamine
DONT (before glucose in alcoholics)
What imaging is essential in evaluating coma? Non-contrast head CT to rule out hemorrhage, mass lesion, herniation
What are common reversible causes of coma? Hypoglycemia, drug overdose, hepatic encephalopathy, uremia, infection, seizure
(postictal state)
What is Complex Regional Pain Syndrome (CRPS)? Chronic neuropathic pain syndrome with autonomic and inflammatory features
disproportionate to inciting event
