PAEA Internal Medicine EOR Study Guide
2026: High-Yield Q&A with Explanations
Description:
Master your PAEA Internal Medicine End of Rotation exam with our targeted 2026 study guide.
This resource features high-yield practice questions and detailed explanations covering
neurology, cardiology, gastroenterology, and infectious disease, aligned with the latest
guidelines. Designed for PA student EOR review, our questions mimic the exam's style to
boost your confidence and clinical reasoning. Stop searching through endless notes and start
focusing on what really matters for your score.
Download your free study guide now and conquer your IM EOR!
, 2026 PAEA Internal Medicine EOR Review: High-Yield Q&A
Study Guide
1. A 45-year-old patient presents with acute onset of unilateral facial droop, inability to
fully close the left eye, and noticeable weakness when raising the left eyebrow. Which of the
following is the most appropriate initial management?
a) Immediate tPA administration
b) Prednisone and Valacyclovir
c) IV Labetalol
d) Aspirin and Clopidogrel
Answer: B
Explanation: The presentation is classic for Bell's Palsy, an idiopathic cranial nerve VII palsy
characterized by forehead involvement (which helps distinguish it from a central stroke). First-
line treatment involves corticosteroids like prednisone (e.g., 60mg daily for 5 days) to reduce
inflammation and an antiviral agent like valacyclovir (e.g., 1g TID for 7 days) in cases
potentially linked to herpes virus reactivation. Supportive care includes eye protection with
artificial tears and lubricating ointment.
2. For which patient is thrombolytic therapy (tPA) most appropriate for an acute ischemic
stroke?
a) A patient with symptom onset 4 hours ago and a CT head showing a small hemorrhage.
b) A patient with symptom onset 2 hours ago and a non-contrast CT head showing no
hemorrhage.
c) A patient with a severe headache and a confirmed subarachnoid hemorrhage on CT.
d) A patient with fluctuating symptoms for the past 12 hours.
Answer: B
Explanation: The primary eligibility criteria for tPA in ischemic stroke include presentation
within the approved time window (within 3.0 or 4.5 hours depending on specific criteria, with <3
hours being a core standard) and the crucial exclusion of intracranial hemorrhage on a non-
contrast CT scan. Answer choices A and C involve contraindications (hemorrhage), and D falls
outside the standard time window.
,3. A patient is diagnosed with a hemorrhagic stroke. Which of the following is a critical
component of their acute management?
a) Immediate administration of aspirin
b) Initiation of a heparin drip
c) Prophylactic anticonvulsant therapy
d) Aggressive blood pressure reduction with nitroprusside as first-line
Answer: C
Explanation: In hemorrhagic stroke, antiplatelet (e.g., aspirin) and anticoagulant (e.g., heparin)
therapies are contraindicated as they can worsen the bleed. Patients are at a significantly
increased risk for seizures; therefore, prophylactic anticonvulsants (e.g., levetiracetam or
phenytoin) are often administered. While blood pressure control is important, agents like
labetalol or nicardipine are typically preferred over nitroprusside due to a more favorable risk
profile.
4. A 72-year-old patient presents with a sudden, severe "thunderclap" headache described
as "the worst headache of my life," followed by neck stiffness. What is the most sensitive
initial diagnostic test?
a) MRI Brain with contrast
b) Lumbar Puncture
c) Non-contrast CT Head
d) Cerebral Angiography
Answer: C
Explanation: A non-contrast CT head is the initial test of choice for a suspected subarachnoid
hemorrhage (SAH) due to its high sensitivity in detecting acute blood within the first 24 hours. If
the CT is negative but clinical suspicion remains high, a lumbar puncture is performed to look
for xanthochromia or red blood cells, which may not be present until 12 hours post-ictus.
5. Which clinical feature best distinguishes delirium from dementia?
a) Progressive memory loss over years
b) Impaired attention and an acute fluctuation in consciousness
c) The presence of hallucinations and delusions
d) Irreversible cognitive decline
, Answer: B
Explanation: Delirium is characterized by an acute, transient disturbance in attention,
awareness, and cognition, with a fluctuating course. It often involves altered sleep-wake cycles
(sundowning). Dementia, in contrast, involves a chronic, progressive decline in cognitive
function. While hallucinations can occur in both, the acute onset and fluctuating nature are
hallmarks of delirium.
6. A patient presents with ascending, symmetric muscle weakness and areflexia that began
10 days after a respiratory illness. Cerebrospinal fluid analysis shows elevated protein with
a normal white blood cell count. What is the most likely diagnosis?
a) Myasthenia Gravis
b) Multiple Sclerosis
c) Guillain-Barré Syndrome
d) Amyotrophic Lateral Sclerosis
Answer: C
Explanation: Guillain-Barré Syndrome (GBS) is an acute inflammatory polyneuropathy often
preceded by an infection. It classically presents with ascending, symmetric weakness and loss of
deep tendon reflexes. The CSF finding of albuminocytological dissociation (elevated protein
with normal WBC count) is highly characteristic.
7. A 68-year-old patient reports new-onset headache, scalp tenderness, and jaw pain when
chewing. On exam, you note a tender, nodular temporal artery. What is the most urgent
next step in management?
a) Schedule a temporal artery biopsy for next week.
b) Initiate high-dose corticosteroid therapy immediately.
c) Prescribe high-dose Ibuprofen for pain control.
d) Order an MRI of the brain to rule out metastasis.
Answer: B
Explanation: This presentation is highly suggestive of Giant Cell Arteritis (GCA), a medical
emergency due to the risk of permanent vision loss from anterior ischemic optic neuropathy.
High-dose corticosteroids (e.g., Prednisone 40-60 mg/day) should be started immediately upon
suspicion, without waiting for temporal artery biopsy confirmation.
2026: High-Yield Q&A with Explanations
Description:
Master your PAEA Internal Medicine End of Rotation exam with our targeted 2026 study guide.
This resource features high-yield practice questions and detailed explanations covering
neurology, cardiology, gastroenterology, and infectious disease, aligned with the latest
guidelines. Designed for PA student EOR review, our questions mimic the exam's style to
boost your confidence and clinical reasoning. Stop searching through endless notes and start
focusing on what really matters for your score.
Download your free study guide now and conquer your IM EOR!
, 2026 PAEA Internal Medicine EOR Review: High-Yield Q&A
Study Guide
1. A 45-year-old patient presents with acute onset of unilateral facial droop, inability to
fully close the left eye, and noticeable weakness when raising the left eyebrow. Which of the
following is the most appropriate initial management?
a) Immediate tPA administration
b) Prednisone and Valacyclovir
c) IV Labetalol
d) Aspirin and Clopidogrel
Answer: B
Explanation: The presentation is classic for Bell's Palsy, an idiopathic cranial nerve VII palsy
characterized by forehead involvement (which helps distinguish it from a central stroke). First-
line treatment involves corticosteroids like prednisone (e.g., 60mg daily for 5 days) to reduce
inflammation and an antiviral agent like valacyclovir (e.g., 1g TID for 7 days) in cases
potentially linked to herpes virus reactivation. Supportive care includes eye protection with
artificial tears and lubricating ointment.
2. For which patient is thrombolytic therapy (tPA) most appropriate for an acute ischemic
stroke?
a) A patient with symptom onset 4 hours ago and a CT head showing a small hemorrhage.
b) A patient with symptom onset 2 hours ago and a non-contrast CT head showing no
hemorrhage.
c) A patient with a severe headache and a confirmed subarachnoid hemorrhage on CT.
d) A patient with fluctuating symptoms for the past 12 hours.
Answer: B
Explanation: The primary eligibility criteria for tPA in ischemic stroke include presentation
within the approved time window (within 3.0 or 4.5 hours depending on specific criteria, with <3
hours being a core standard) and the crucial exclusion of intracranial hemorrhage on a non-
contrast CT scan. Answer choices A and C involve contraindications (hemorrhage), and D falls
outside the standard time window.
,3. A patient is diagnosed with a hemorrhagic stroke. Which of the following is a critical
component of their acute management?
a) Immediate administration of aspirin
b) Initiation of a heparin drip
c) Prophylactic anticonvulsant therapy
d) Aggressive blood pressure reduction with nitroprusside as first-line
Answer: C
Explanation: In hemorrhagic stroke, antiplatelet (e.g., aspirin) and anticoagulant (e.g., heparin)
therapies are contraindicated as they can worsen the bleed. Patients are at a significantly
increased risk for seizures; therefore, prophylactic anticonvulsants (e.g., levetiracetam or
phenytoin) are often administered. While blood pressure control is important, agents like
labetalol or nicardipine are typically preferred over nitroprusside due to a more favorable risk
profile.
4. A 72-year-old patient presents with a sudden, severe "thunderclap" headache described
as "the worst headache of my life," followed by neck stiffness. What is the most sensitive
initial diagnostic test?
a) MRI Brain with contrast
b) Lumbar Puncture
c) Non-contrast CT Head
d) Cerebral Angiography
Answer: C
Explanation: A non-contrast CT head is the initial test of choice for a suspected subarachnoid
hemorrhage (SAH) due to its high sensitivity in detecting acute blood within the first 24 hours. If
the CT is negative but clinical suspicion remains high, a lumbar puncture is performed to look
for xanthochromia or red blood cells, which may not be present until 12 hours post-ictus.
5. Which clinical feature best distinguishes delirium from dementia?
a) Progressive memory loss over years
b) Impaired attention and an acute fluctuation in consciousness
c) The presence of hallucinations and delusions
d) Irreversible cognitive decline
, Answer: B
Explanation: Delirium is characterized by an acute, transient disturbance in attention,
awareness, and cognition, with a fluctuating course. It often involves altered sleep-wake cycles
(sundowning). Dementia, in contrast, involves a chronic, progressive decline in cognitive
function. While hallucinations can occur in both, the acute onset and fluctuating nature are
hallmarks of delirium.
6. A patient presents with ascending, symmetric muscle weakness and areflexia that began
10 days after a respiratory illness. Cerebrospinal fluid analysis shows elevated protein with
a normal white blood cell count. What is the most likely diagnosis?
a) Myasthenia Gravis
b) Multiple Sclerosis
c) Guillain-Barré Syndrome
d) Amyotrophic Lateral Sclerosis
Answer: C
Explanation: Guillain-Barré Syndrome (GBS) is an acute inflammatory polyneuropathy often
preceded by an infection. It classically presents with ascending, symmetric weakness and loss of
deep tendon reflexes. The CSF finding of albuminocytological dissociation (elevated protein
with normal WBC count) is highly characteristic.
7. A 68-year-old patient reports new-onset headache, scalp tenderness, and jaw pain when
chewing. On exam, you note a tender, nodular temporal artery. What is the most urgent
next step in management?
a) Schedule a temporal artery biopsy for next week.
b) Initiate high-dose corticosteroid therapy immediately.
c) Prescribe high-dose Ibuprofen for pain control.
d) Order an MRI of the brain to rule out metastasis.
Answer: B
Explanation: This presentation is highly suggestive of Giant Cell Arteritis (GCA), a medical
emergency due to the risk of permanent vision loss from anterior ischemic optic neuropathy.
High-dose corticosteroids (e.g., Prednisone 40-60 mg/day) should be started immediately upon
suspicion, without waiting for temporal artery biopsy confirmation.
