PAEA Internal Medicine EOR
PAEA Internal Medicine EOR Exam Study Guide
Questions with Answers 2025
Bell's Palsy - Correct Ans-causes cranial nerve 7 dysfunction
S/S of Bell's Palsy - Correct Ans-Has forehead involvement (whereas a stroke does not
affect forehead movement), facial weakness, inability to keep one eye closed
Treatment for Bell's palsy - Correct Ans-Prednisone 60mg x 5 days, Valcyclovir 1000mg
TID x 7 days, artificial tears, lacri lube at night
Define stroke - Correct Ans-any disease process that interrupts blood flow to brain
Diagnosis of stroke (gold standard) - Correct Ans-CT angiography
Traditional signs and symptoms of a stroke - Correct Ans-sudden numbness/weakness,
sudden confusion/aphasia, memory deficit, visual deficit, dizzy, sudden HA with no
cause
When can I use tPA? - Correct Ans-ischemic stroke presenting within <3 hrs and CT
head negative
Dosing of tPA - Correct Ans-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? - Correct Ans-Nitroprusside (short half life, easy
to titrate) or IV labetalol
What do you use for anticoagulation/antiplatelet therapy in stroke? - Correct Ans-ASA
(not in hemorrhagic), heparin for thrombosis
What do you do differently to treat hemorrhagic stroke? - Correct Ans-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? -
Correct Ans-No headache, not visible on CT without contrast until 6 hours post stroke
What are the types of Ischemic Stroke? - Correct Ans-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
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,PAEA Internal Medicine EOR
Types of Hemorrhagic Stroke - Correct Ans-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? - Correct Ans-HTN, amyloidosis,
iatrogenic anticoagulation, vascular malformations, cocaine use
Causes of Subarachnoid hemorrhagic stroke are what? - Correct Ans-berry aneurysm
rupture, vascular malformation rupture
Signs and symptoms of Intracerebral hemorrhagic stroke are what? - Correct Ans-ICP
rises, vasoconstriction-sweating
Signs and symptoms of Subarachnoid hemorrhagic stroke are what? - Correct Ans-may
be preceded by warning headache, neck/back pain, "worst headache of my life,"
thunderclap, may have loss of consciousness
Treatment of Subarachnoid hemorrhage - Correct Ans-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? - Correct Ans-Complex regional pain
syndrome (CRPS)
Signs and symptoms of complex regional pain syndrome are what? - Correct Ans-
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 - Correct Ans-Amitriptyline, nortriptyline,
gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive
therapy; Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation
Ruptured saccular berry aneurysm counts for _____% of nontraumatic cases of
subarachnoid hemorrhage. - Correct Ans-75%
Imaging modality used to diagnose Subarachnoid Hemorrhage? - Correct Ans-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 - Correct Ans-transient disorder characterized by impaired attention,
perception, memory and cognition. Sleep wake cycles interrupted ("sundowning").
Reduced alertness, activity levels change rapidly.
2|Page
,PAEA Internal Medicine EOR
Treatment of Delirium - Correct Ans-treat underlying cause, Haloperidol 5-10mg for
agitation, Lorazepam 0.5-2 mg
Dementia - Correct Ans-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 - Correct Ans-Antipsychotics to manage psychosis
GCS - Correct Ans-
Essential tremor does not occur at rest, occurs bilaterally, and has no indication of other
neuro signs. How do you treat essential tremor? - Correct Ans-Propranolol, Primidone
(can combine these 2 if needed)
Guillian Barre Syndrome - Correct Ans-Idiopathic polyneuropathy often following minor
infections, immunizations or surgical procedures. Most times no cause is identified.
How long does Guillian Barre Syndrome last? - Correct Ans-worst at 2-4 weeks after
onset, plateaus next 2-4 weeks, remits weeks-moats
Signs and symptoms of Guillian Barre Syndrome - Correct Ans-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? - Correct Ans-no fever at onset, CSF protein >45
and low WBC, MRI shows selective enhancement of anterior spinal nerve roots
Treatment of Guillian Barre Syndrome - Correct Ans-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? - Correct Ans-Giant cell arteritis
Signs and symptoms of Giant Cell Arteritis - Correct Ans-headache, scalp tenderness,
jaw claudication, throat pain, diplopia
Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis
Giant Cell Arteritis - Correct Ans-Steroids immediately, do not wait for biopsy results.
Give low dose aspirin too.
3|Page
, PAEA Internal Medicine EOR
Describe a Migraine Headache? - Correct Ans-unilateral location, pulsatile quality,
moderate to severe intensity, aggravated by movement, nausea, vomiting, photophobia,
phonophobia
lasting 4-72 hours
Migraine treatment - Correct Ans-NSAIDs, Triptans, antiemetics
What do you use in conjunction with abortive therapies for migraine to reduce risk of
early headache recurrence? - Correct Ans-dexamethasone 10-25 mg IV/IM
What is a Cluster Headache? - Correct Ans-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 - Correct Ans-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 - Correct Ans-
Verapamil 240-960mg given in 3 daily doses
Preventive therapies for cluster headache lasting less than 2 months - Correct Ans-
Prednisone 60-100mg daily x5 days, taper with 10mg
What is a Tension Headache? - Correct Ans-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 - Correct Ans-NSAIDs or ASA combined with caffeine. APAP less
effective but preferred in pregnancy. 2nd line therapies are antidepressants
(amitriptyline)
What is the difference between a primary and a secondary headache? - Correct Ans-
Primary has no underlying etiology. Secondary results from underlying disease, mass,
infection, CVA, trauma, drug withdrawal, metabolic disorders.
Huntington Disease - Correct Ans-inherited disorder, develops after 30 years old,
progressive chorea and dementia, usually fatal within 15-20 years
Signs and symptoms of Huntington Disease - Correct Ans-mental changes, restless,
dystonic posturing, severe choreiform movements
Empiric treatment for bacterial meningitis - Correct Ans-Ceftriaxone 2g IV and
Vancomycin =/- Acyclovifr, Dexamethasone 10 mg IV; spupportive care
4|Page
PAEA Internal Medicine EOR Exam Study Guide
Questions with Answers 2025
Bell's Palsy - Correct Ans-causes cranial nerve 7 dysfunction
S/S of Bell's Palsy - Correct Ans-Has forehead involvement (whereas a stroke does not
affect forehead movement), facial weakness, inability to keep one eye closed
Treatment for Bell's palsy - Correct Ans-Prednisone 60mg x 5 days, Valcyclovir 1000mg
TID x 7 days, artificial tears, lacri lube at night
Define stroke - Correct Ans-any disease process that interrupts blood flow to brain
Diagnosis of stroke (gold standard) - Correct Ans-CT angiography
Traditional signs and symptoms of a stroke - Correct Ans-sudden numbness/weakness,
sudden confusion/aphasia, memory deficit, visual deficit, dizzy, sudden HA with no
cause
When can I use tPA? - Correct Ans-ischemic stroke presenting within <3 hrs and CT
head negative
Dosing of tPA - Correct Ans-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? - Correct Ans-Nitroprusside (short half life, easy
to titrate) or IV labetalol
What do you use for anticoagulation/antiplatelet therapy in stroke? - Correct Ans-ASA
(not in hemorrhagic), heparin for thrombosis
What do you do differently to treat hemorrhagic stroke? - Correct Ans-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? -
Correct Ans-No headache, not visible on CT without contrast until 6 hours post stroke
What are the types of Ischemic Stroke? - Correct Ans-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
1|Page
,PAEA Internal Medicine EOR
Types of Hemorrhagic Stroke - Correct Ans-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? - Correct Ans-HTN, amyloidosis,
iatrogenic anticoagulation, vascular malformations, cocaine use
Causes of Subarachnoid hemorrhagic stroke are what? - Correct Ans-berry aneurysm
rupture, vascular malformation rupture
Signs and symptoms of Intracerebral hemorrhagic stroke are what? - Correct Ans-ICP
rises, vasoconstriction-sweating
Signs and symptoms of Subarachnoid hemorrhagic stroke are what? - Correct Ans-may
be preceded by warning headache, neck/back pain, "worst headache of my life,"
thunderclap, may have loss of consciousness
Treatment of Subarachnoid hemorrhage - Correct Ans-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? - Correct Ans-Complex regional pain
syndrome (CRPS)
Signs and symptoms of complex regional pain syndrome are what? - Correct Ans-
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 - Correct Ans-Amitriptyline, nortriptyline,
gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive
therapy; Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation
Ruptured saccular berry aneurysm counts for _____% of nontraumatic cases of
subarachnoid hemorrhage. - Correct Ans-75%
Imaging modality used to diagnose Subarachnoid Hemorrhage? - Correct Ans-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 - Correct Ans-transient disorder characterized by impaired attention,
perception, memory and cognition. Sleep wake cycles interrupted ("sundowning").
Reduced alertness, activity levels change rapidly.
2|Page
,PAEA Internal Medicine EOR
Treatment of Delirium - Correct Ans-treat underlying cause, Haloperidol 5-10mg for
agitation, Lorazepam 0.5-2 mg
Dementia - Correct Ans-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 - Correct Ans-Antipsychotics to manage psychosis
GCS - Correct Ans-
Essential tremor does not occur at rest, occurs bilaterally, and has no indication of other
neuro signs. How do you treat essential tremor? - Correct Ans-Propranolol, Primidone
(can combine these 2 if needed)
Guillian Barre Syndrome - Correct Ans-Idiopathic polyneuropathy often following minor
infections, immunizations or surgical procedures. Most times no cause is identified.
How long does Guillian Barre Syndrome last? - Correct Ans-worst at 2-4 weeks after
onset, plateaus next 2-4 weeks, remits weeks-moats
Signs and symptoms of Guillian Barre Syndrome - Correct Ans-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? - Correct Ans-no fever at onset, CSF protein >45
and low WBC, MRI shows selective enhancement of anterior spinal nerve roots
Treatment of Guillian Barre Syndrome - Correct Ans-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? - Correct Ans-Giant cell arteritis
Signs and symptoms of Giant Cell Arteritis - Correct Ans-headache, scalp tenderness,
jaw claudication, throat pain, diplopia
Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis
Giant Cell Arteritis - Correct Ans-Steroids immediately, do not wait for biopsy results.
Give low dose aspirin too.
3|Page
, PAEA Internal Medicine EOR
Describe a Migraine Headache? - Correct Ans-unilateral location, pulsatile quality,
moderate to severe intensity, aggravated by movement, nausea, vomiting, photophobia,
phonophobia
lasting 4-72 hours
Migraine treatment - Correct Ans-NSAIDs, Triptans, antiemetics
What do you use in conjunction with abortive therapies for migraine to reduce risk of
early headache recurrence? - Correct Ans-dexamethasone 10-25 mg IV/IM
What is a Cluster Headache? - Correct Ans-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 - Correct Ans-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 - Correct Ans-
Verapamil 240-960mg given in 3 daily doses
Preventive therapies for cluster headache lasting less than 2 months - Correct Ans-
Prednisone 60-100mg daily x5 days, taper with 10mg
What is a Tension Headache? - Correct Ans-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 - Correct Ans-NSAIDs or ASA combined with caffeine. APAP less
effective but preferred in pregnancy. 2nd line therapies are antidepressants
(amitriptyline)
What is the difference between a primary and a secondary headache? - Correct Ans-
Primary has no underlying etiology. Secondary results from underlying disease, mass,
infection, CVA, trauma, drug withdrawal, metabolic disorders.
Huntington Disease - Correct Ans-inherited disorder, develops after 30 years old,
progressive chorea and dementia, usually fatal within 15-20 years
Signs and symptoms of Huntington Disease - Correct Ans-mental changes, restless,
dystonic posturing, severe choreiform movements
Empiric treatment for bacterial meningitis - Correct Ans-Ceftriaxone 2g IV and
Vancomycin =/- Acyclovifr, Dexamethasone 10 mg IV; spupportive care
4|Page
